BackgroundThe Mongolian Government is regularly concerned on the hospital development and the improvementof hospital structure and function at the health sectors’ policy level. Therefore, there is a need ofevidence based survey that is determine possible ways in improving hospital management throughthe management function (organization, planning, decision making, leadership-motivation, monitoringand evaluation management) and management component (human resources, information,marketing, finance, foreign relationship and cooperation).ObjectiveTo outline possible approaches in improving clinical hospital management upon reviewing of itscurrent settingMaterials and MethodsThe study was conducted by qualitative method and data was collected through applying discussionsand participatory approaches. In total, 155 participants were enrolled in the study, from which 72were covered by the Focus Group Discussions, and the remained 83 were studied for OrganizationalDiagnostic Analysis.ResultsThe Clinical hospital management aspects are reasonably unsatisfactory (61.4%). As a result ofsurvey, clinical hospital structure, organization and coordination (76%), monitoring and evaluationmanagement (72.8%), planning (71.6%) encompass comparatively predominant advantageswhereas decision making management (67.5%), motivation (59.6%), human resources management(62.4%), information management (57.8%), financial management (52.9%), and hospital marketing(30%) enclose prevailing disadvantages. According to the hospital policy analysis, there were hospitalpriority issues such as inappropriate hospital structure, the weak hospital governance, monitoringand responsibility, financial system is separate and it could not the right financial lever, do not havehospital capacity planning and repairing system, private sector’s role is indefinite and coordinationis limited. There recommended 4 hospital policy approaches.Conclusion: Advantages and Disadvantages of the Clinical hospital management levels, althoughthey vary, management aspects are reasonably unsatisfactory. If to view in an isolation by eachkey role and direction of the management functions, organization, planning, monitoring andevaluation management encompass comparatively predominant advantages whereas humanresources, information, finance, motivation, and decision making management enclose prevailingdisadvantages. In terms of hospital marketing, it is extremely poor. Therefore, there are neededfor improving of hospital management and marketing through the hospital 4 policy approaches byphase.

A child’s career aspirations are based on a number of external factors such as ethnicity, gender, age, income, family influence and socioeconomic status. These factors are interrelated and given varying degrees of importance culturally, for example, in the UK, white British parents tend to have high aspirations for their daughters whereas, in Pakistani and Bangladeshi families, daughters are expected to marry, not excel in their education or career. High school students of secondary education in terms of gender, 34432 studentsenrolled in high school who are studying in 46.47% of men and women are 53.52% of the high school, there are changes in the gender disparity. This study is conducted due to Millennium Development Goal 3 is to eliminate gender disparity in education by 2015. This study was conducted among General Education School students of Ulaanbaatar city in 2015. Three hundred twenty four school students participated in this study. The cross sectional study was conducted with 294 high school students.Thirty high school students participated in focus group interview. This study was used qualitative and quantities design.Of the respondents, 47.6% were male and 52.4% female. 79.3% of high school students have chosen a career and 20.7% of high school students have not chosen yet. We are evaluated in career choice with a focus on a gender issue. P = 0.0001 whether there are statistically significant and career choice have different in men and women gender.In this study, 20.7 percent of high school students do not choose career due to a lack of information,do not give the professional advice from the school for them. Thus, schools need to introduce if possible considering the foreign experience, lesson of career choice is reflected in the school curriculum.

Introduction: According to the statistical data of health organization 43% of all diseases and 60% of all deaths are due to chronic diseases including cardiovascular diseases, diabetes mellitus and cancer. Many factors contribute to the wide spread of noncommunicable diseases (NCDs)1. As defined in the World Health Report 2002, many common risk factors such as unhealthy diet, physical inactivity, smoking, alcohol use, overweight, raised blood pressure, raised total cholesterol levels and blood sugar are the most prevalent risk factors among the world population. In conclusion, the Mongolian NCD STEPs survey of 2006 revealed that 9 in every 10 people had at least one risk factors for developing NCDs. One in every 5 people had three and more risk factors for developing NCD3. However, partial studies of NCDs, which are dominant in Mongolia, had been conducted previously; the possibilities of wide use of the results are limited and those studies covered only adult people. So it is very important to evaluate knowledge about nutrition and food, tendency and practical experience about life style, activity of motion and use of food among the children.Objective: The goal of the study was to determine the prevalence of risk factors for NCDs among schoolchildren and to develop recommendation and suggestion for prevention of non communicable diseases.Materials and Methods: The survey covered 1504 students, studying in 20 middle and high schools, which are located 5 districts of UB, and was conducted by cross-sectional methods using questionnaire and anthropometric measurements (height, weight and BMI).Results and Conclusion: 31.3% of surveyed population did not consume any serving size of fruits per day, 68.7% consumed less than 5 serving sizes. The second common source of fat was fatty meat and butter. The prevalence of tobacco use was 6.1% of the surveyed population. School children do sedentary work, which has low energy consumption, after class. They watch TV for 3.53±1.24 hours and work on computer 2.83±1.07 hours a day. Percentage of the students who involved in some kind of sports activities is 71.2%, whereas 28.8% of them do not do any physical exercise. The reason why they do not participate in sports activities was determined as follows: do not have enough free time 37.2%, do not like sports 5.3%, due to high fees 35.1%, and inconvenient locations of sport facilities 18.2%. Although the laws, resolutions and regulations, supporting public sports are enough, the structure and action of the units that implement, evaluate and control these laws and regulations are weak.

Learning objectives: After reading this article, readers should be able to:1. Get information about brief historical aspects of the cleft palate treatment;2. Understand techniques used to repair various types of the cleft palate;3. Understand the optimal timing of the cleft palate repair;4. Understand the results and complications following palate repair including speech, maxillary growth, and fistula formation, regarding with operative techniques and timing of palatoplasty.Summary: Cleft palate is more common congenital anomaly, but surgeons have been eluding surgical correction of the cleft palate for centuries. Many surgical techniques have been described during last two centuries, the goals of these include separating the nasal and oral cavities (avoiding fistulas), establishing normal speech, and preserving maxillofacial growth. This article reviews the brief historical aspects of the cleft palate, palatoplasty techniques, the optimal timing, and the results and complication associated with palate repair technique and timing.

There is a little information about weight excess of school materials in Ulaanbaatar, Mongolia. The aim of this study was to study of the weight of backback and the ergonomic effects of backpack carriage on school students in Ulaanbaatar. This cross-sectional study was performed in the city of Ulaanbaatar in 2015. Two hundred fourteen school students participated in study. Nordic Musculoskeletal Questionnaire was used, asking about complaints of neck, shoulders, upper and lower back. Length and weight of the children were determined. Backpacks were weighed and the relative weight of the backpack was calculated.In this study, first and second grades students carried proportionately heavier backpacks than older students and more than 10% of their weight. Musculoskeletal complaints were reported by about 79% of school students. The (relative) weight of backpacks was not related to complaints of neck, shoulders, upper and lower back.

BACKGROUND: Tuberculosis (TB) morbidity and mortality has been one of the pressing issues in the health sector of our country. In Mongolia, 2 people out of 1000 people developed tuberculosis annually, which leads to becoming one of the 7 countries with high TB morbidity among 37 countries of the Western Pacifi c Region.OBJECTIVE: The aim of the study is to have the baseline to understand and measure knowledge, attitudes and practices regarding tuberculosis among non-tuberculosis health care workers including family group practitioners, nurses and specialized doctors at the primary, secondary and tertiary health care level of Mongolia.MATERIALS AND METHOD: Cross-sectional descriptive qualitative study. Self-admitted questionnaire were performed for 572 health care workers. Total of 4 aimags/provinces and 3 districts were randomly selected. Selenge, Darkhan-Uul, and Khentii aimags are regions with high tuberculosis burden, Dornogobi and Orkhon aimags are with low Tuberculosis incidence and prevalence in 2008.Altogether 572 doctors and health professionals from selected health facilities were involved in survey questionnaire and 39.9% (228 people) of respondents were working at the primary level, 31.3% (179 people) in secondary level, and 28.8% (165 people) in the tertiary level health facility, respectively. Altogether 23 focus group discussions were organized, involving 130 people.RESULTS: Around 98.6% of respondents answered that TB is spread when infected person coughs and sneezes. However, one of every three respondents answered TB can be transmitted when sharing cups, dishes and other cooking utensils with the infected person, one in every ten people–shaking hands with the infected person, and one in every four people–through mother to child transmission. Such misconception is common among the health professionals, especially among nurses of the secondary and tertiary level health facilities. Around 47.6% or 272 people answered correctly that TB patients have symptoms such as coughing for 2 weeks and longer, develop sputum with blood traces, fever and sweating during night sleep, and loss of weight. However, there is some misunderstanding among the doctors and nurses such as there are skin rashes. When doctors and nurses where asked which form of TB is the infectious one, 86.9% answered correctly that TB with positive smear test is infectious. On assessing the knowledge, attitude and practice on TB treatment, about 93.4% of the respondents answered that treatment shall be done by anti-TB drugs and this result is equally strong among health professionals at all service delivery levels (p=0.075). However, there are some misconceptions among the nurses that TB patients should buy anti-TB drugs from the pharmacies, try traditional medicines and follow religious rituals. This should be paid further attention and issues covering TB should be included in their curriculum. Every second person knows the treatment continuation period of drug susceptible TB patient, which is relatively low knowledge level. According to survey results, every second person knows what DOTS stand for. In other words, 55.4% of the respondents identifi ed correctly what is DOTS, and 13.8% answered that it is a combination of anti-TB drugs, 3 .3% - as TB treatment method, 5.6% - as combination of TB reduction measures, and 2.2% answered that they don’t know.CONCLUSION: Many misunderstandings were found in the fi eld of transmission, BCG vaccination, treatment and anti-TB drugs. There is a need to provide training for non-TB medical doctors and nurses.

BackgroundAn estimated 522 066 students are studying in secondary school of Mongolia and it was 19% of total population. Population life expectancy and health status is directly related to adolescents’ health, as many chronic disease conditions are affiliated with adolescence. Many premature deaths among adults result from behavior initiated during adolescence. According to the NRC survey, one in thirteen schoolchildren (7.3%) was underweight, 16.3% was stunting, and 13.8% were iodine deficiency. It has taken 52.8% of total daily energy among 11-14 years schoolchildren and 50.5% were between 15 and 17 ages. In addition, research in Mongolia in 2005 indicate serious problems in healthy eating behavior; 8% of adolescents consumed milk products on daily basis, 71.7% had breakfast only sometimes, and 83.2% had a meal one time per day. Micronutrient deficiency such as anemia, A, D vitamins among them is cause of low consumption of vegetable and fruits. There is a need to study schoolchildren’s dietary recall.ObjectiveTo study and evaluate schoolchildren’s nutritional statusMaterials and MethodsThe descriptive and cross sectional study was carried out in 4 districts of Ulaanbaatar city (750 schoolchildren from each district) and 2 aimags (889 schoolchildren from Uvurkhangai and 925 from Dornod) of Mongolia. Also determined current nutrition situation of surveyed schoolchildren by using 24 hours recall method and assessed.ResultA total of 4760 (46.6% boys and 53.4% girls) school children surveyed and 46.6% were boys and 53.4% were girls. 71.7 percent of total respondents have breakfast sometimes, 83.2 of them have a lunch only one time per day, and 38.3 percent of total daily energy takes from dinner and have not any difference between age groups. Adolescent aged 7-10 years takes 92.7 percent of total calorie, 90.1 percent of protein, 93.9 percent of carbohydrate and 92.3 percent of fat compared to RDI of Mongolia and thus animale fat is the 1.6 times more than the norm. Consumption of vitamins and minerials such as vitamin A, and iron8 calcium were insufficient among schoolchildren. Specially, it was lower among male student than female. For instance vitamin C intake was 48.0- 58.6 percent among female students aged above 11 years and it was 47.3- 51.8 percent for male students. About 30 percent of total calcium is consumed per day among overal respondents. Conclusions:1. Daily intake of basic nutrients and energy is lower by 10-30 percent than RDI of Mongolia among schoolchildren.2. High consumption of in diet among male adolescents of age 15 years and above causes disbalance of adequate ratio of main nutrients as protein8 fat and carbohydrates.3. There is not enough suffecient consumption of vitamins and minerials specially calcium.

Introduction: Foodborne diseases are a major public health concern worldwide. The report, which estimates the burden of foodborne diseases – states that each year as many as 600 million, or almost 1 in 10 people in the world, fall ill after consuming contaminated food. Of these, 420 000 people die, including 125 000 children under the age of 5 years. The 20.3% of diarrhea and 27.5% of die caused by contaminated foods are diarrheagenic Escherichia coli (DEC). Aim: To identify of DEC and determine their antibiotic resistance from ready-to-eat salads Material and Methods: A total of 40 bagged salad mix samples were collected from food markets in Ulaanbaatar, Mongolia. Escherichia coli (E.coli) strains were determined on the basis of MNS 6308:2012 standard and confirmed by polymerase chain reaction (PCR) in samples. DEC was identified using multiplex PCR. Bacterial susceptibility to antimicrobial agents determined by the Kirby Bauer disk diffusion method. Results: Our results showed the presence of E. coli in 19 samples (47.5%). DEC isolates identified by multiplex PCR were defined as follows: the presence of eae and bfp for EPEC, the presence of lt for ETEC, the presence of ipaH for EIEC, the presence of stx1 and stx2 for EHEC, the presence of aap and aggR for EAEC, and the presence of daaE for DAEC. The multiplex PCR assays detected EHEC 6 (31.6%), EPEC 5 (26.3%), EIEC 1 (5.3%). EAEC and ETEC were not detected in samples. The E.coli isolates were 73.7% resistant to chloramphenicol as the first choice of treatment of diarrhea and high resistance (68.4-94.7%) to the cephalosporins. In our country, cephalosporins are widely used in medical practice for the treatment of infectious diseases. Conclusion In this study, about half of ready-to-eat salads are contaminated with E. coli. The three types (EHEC, EPEC, EIEC) of DEC pathotypes were identified in the ready-to-eat salads and high prevalent of antimicrobial resistance. Future research is required to track the contamination sources and develop appropriate steps that should be taken by industry and retailers to reduce microbial contamination in ready-to-eat salads.

BACKGROUND. Previous retrospective study from our team showed that RDW significantly increased in chronic heart failure (CHF). OBJECTIVE. The aim of the study was to compare the value of RDW-CV with NT-pro BNP and evaluate sensitivity and specificity of RDW for diagnose of heart failure. MATEREALS AND METHOD. Here, we analyzed 20 patients who were suffering from heart failure and were treated in the department of Cardiology, First Clinical Hospital between in June 2017. All patients in the study group were underwent a complete blood count, immunoassay for NT-proBNP. The ejection fraction was analyzed by ECHO cardiograpy. RESULTS. 85.0% of patients were male and remained was female. RBC and RDW was significantly differentially measured in between CHF groups (р= 0.028 p=0.0001). In control groups without heart failure NT-proBNP was estimated up to 100 pg/ml, whereas it was definitelly increased in patient with CHF (р=0.0001). There was strong correlation between RDW and NT-proBNP (r =0.846, p=0.0001). sensitivity and specificity of RDW was 89%, and 74.3 % respectively in CHF. CONCLUSION. According to the our results there was direct correlation between RDW-CV and heart failure (p=0.035). RDW-CV migh be cost effective and routine laboratoty marker to evaulate CHF.

BACKGROUND: Tuberculosis (TB) and indoor air pollution (IAP) are equally critical public health issues in the developing world. Mongolia is experiencing the double burden of TB and IAP due to solid fuel combustion. However, no study has assessed the relationship between household solid fuel use and TB in Mongolia. The present study aimed to assess the association between household solid fuel use and TB based on data from the Mongolian National Tuberculosis Prevalence Survey (MNTP Survey). METHOD: The MNTP Survey was a nationally representative population-based cross-sectional survey targeting households in Mongolia from 2014 to 2015, with the aim of evaluating the prevalence of TB. The survey adopted a multistage cluster sampling design in accordance with the World Health Organization prevalence survey guidelines. Clusters with at least 500 residents were selected by random sampling. A sample size of 98 clusters with 54,100 participants was estimated to be required for the survey, and 41,450 participants were included in the final analysis of the present study. A structured questionnaire was used to collect information on environmental and individual factors related to TB. Physical examination, chest X-ray, and sputum examinations were also performed to diagnose TB. RESULTS: The use of solid fuels for heating (adjusted odds ratio (aOR): 1.5; 95% confidence interval (CI): 1.1-2.1), male gender (aOR: 2.2; 95% CI: 1.6-3.2), divorced or widowed (aOR: 2.6; 95% CI: 1.7-3.8), daily smoker (aOR: 1.8; 95% CI: 1.3-2.5), contact with an active TB case (aOR: 1.7; 95% CI: 1.2-2.3), being underweight (aOR: 3.7; 95% CI: 2.4-5.7), and previous history of TB (aOR: 4.3; 95% CI: 3.0-6.1) were significantly associated with bacteriologically confirmed TB after adjusting for confounding variables. CONCLUSION The use of solid fuels for heating was significantly associated with active TB in Mongolian adults. Increased public awareness is needed on the use of household solid fuels, a source of IAP.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Air Pollution, Indoor/adverse effects* ; Cooking ; Cross-Sectional Studies ; Female ; Heating/adverse effects* ; Humans ; Male ; Middle Aged ; Mongolia/epidemiology* ; Prevalence ; Tuberculosis/epidemiology* ; Young Adult